Flexing Mental Muscles

Seeking Solutions

As many as 60 percent of children treated for brain tumors or ALL develop attention and learning problems as a result of their disease or its treatment. Stimulant medications can be effective, but they are not right for everyone. Therapist-led sessions may not be practical because of scheduling or geographical constraints.

Heather Conklin, PhD, of St. Jude Psychology, and her colleagues were determined to find a solution. They designed a study for children and teens who, like Cameron, experienced significant cognitive problems after cancer therapy.

Participants agreed to complete about 25 sessions of a computer program called Cogmed Working Memory Training®. St. Jude researchers tracked the survivors’ performance online and offered reinforcement through weekly telephone coaching sessions.

Not your brother’s video game

Children in the study spent 30 to 45 minutes each day playing games led by a blue, roller-skating robot. The friendly creature introduced exercises that featured asteroids, space animals, twirling lights and other objects. Children relied on verbal or visual cues to recall specific sequences.

Conklin is quick to point out the difference between this software and a video game.

“First, the program is specific—targeting particular skills our patients need to work on,” she says. “Second, it’s intensive, requiring lots of repetition. Just like physical exercise, you must do it frequently for a sustained length of time in order to see results. Third, it’s adaptive—meaning that the difficulty level changes based on performance.”

“I had to push myself to do it,” Cameron admits. “It seemed irrelevant at the time, but it helped me in ways I didn’t realize until later.”

Game changer

Children completing the training program enjoyed significant benefits in attention, working memory and processing speed.

“Cameron’s approach to learning really changed,” his mom says. “It was incredible.”

The results were similar to those of children who take stimulant medications for attention deficit disorders.

“Typically, we don’t see as much improvement with behavioral interventions as we do with medication,” Conklin says, “but in this case, we did.”

Scientists also saw changes in functional brain scans done before and after the program.           

“We saw changes in activation that suggest participants are becoming more efficient at how they approach the tasks,” says Conklin, who recently published results of the study in the Journal of Clinical Oncology.

“We think it means new connections are being made in the brain.”

Next steps

Given the program’s success with survivors, Conklin and her colleagues asked, “Why wait until they’re having problems? Let’s see if we can ward off issues rather than wait until they have them.”

That’s just what they’re doing. The hospital’s latest clinical trial for the brain tumor medulloblastoma incorporates this computer-based training toward the end of therapy.

Cameron continues to benefit from his experience. In fact, he is spending his senior year of high school working on a capstone project titled “Late Cognitive Effects of Cancer Treatment on Children.”

“Teachers might take one look at a kid like me and assume he hasn’t ever been sick a day in his life,” Cameron explains. “But my position is that these cognitive effects could be better understood by the educational system.

“Basically,” he adds, “a better understanding leads to a decrease in difficulties.”

From Promise, Winter, 2016